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Pulmonary embolism (PE) is a disease caused by blood clots, tumor embolism, and other emboli within the pulmonary arteries. Various scoring scales are used for PE. One such same is the PESI, but it has 12 variables, making it inconvenient for clinical application.The aim of this study was to develop a new simple nomogram model to assess 30-day survival in PE patients. The new nomogram makes it easier and faster for clinicians to assess the prognosis of patients with PE.We collected data about the patients with PE from the Medical Information Mart for Intensive Care-III (MIMIC-III) database and used the receiver operating characteristic (ROC) curve, area under the ROC curve (AUROC), calibration plot, integrated discrimination improvement (IDI), and decision curve analysis (DCA) to evaluate the predictive power of the new model, and compared these with the PESI.According to the multivariable Cox regression model results, alongside the actual clinical conditions, we included the following seven variables: race, bicarbonate, age, tumor, systolic blood pressure (SBP), body temperature, and oxygen saturation (Spo2). The AUROC of the new model was greater than 0.70. Its IDI exceeded 0, but with P-value0.05.The predictive performance of the new model was not worse than the PESI, but the new model only has seven variables, and is therefore more convenient for clinicians to use.

Kidney transplantation in mice is a complicated and challenging surgery procedure. There are very few publications demonstrating the key steps of this operation. Therefore, this article introduces the technique and points out the surgical caveats associated with this operation. In addition, important modifications in comparison to the conventional procedure are demonstrated. Firstly, a patch of the abdominal aorta is cut and prepared so that the proximal bifurcations of the renal artery, including the ureteral artery are transected together with the donor kidney en bloc. This reduces the risk of a ureter necrosis and avoids the development of a urinary tract occlusion. Secondly, a new method of the vascular anastomosis is demonstrated that allows the operator to flexibly increase or decrease the size of the anastomosis after renal transplant reperfusion has already been initiated. This avoids the development of vessel strictures and intraabdominal bleeding. Thirdly, a technique that enables the anastomosis of the delicate donor ureter and the recipient bladder that does not cause a trauma is shown. Adopting this protocol can shorten the operation time and reduces the damage to the recipient's bladder, thereby significantly increasing the operation success rate for the recipient mice.

Coronary artery spasm can cause recurrent variant angina with ST-segment elevation. The patient was asymptomatic with normal vitals and ECG was normal. We present a case associated with transient ST-segment elevation and significant increase in troponin levels with non-critical lesion with normal CAG.

Objective:Smokers often exhibit a stronger automatic approach bias toward smoking cues than nonsmokers on the Approach–Avoidance Task. However, previous research has often neglected the temporal dy...

Aim: To investigate the relationship between hemoglobin levels and the progression of IgA nephropathy (IgAN). Methods: In a two-center cohort of 1,828 cases with biopsy-proven IgAN, we examined the association of hemoglobin levels with the primary outcome of a composite of all-cause mortality or kidney failure defined as a 40% decline in eGFR, or ESKD (defined as eGFR 2 or need for kidney replacement therapy including hemodialysis, peritoneal dialysis, or kidney transplantation), or the outcome of kidney failure, assessed using Cox and logistic regression models, respectively, with adjustment for confounders. Results: At baseline, mean age, eGFR, and hemoglobin levels were 33.75 ± 11.03 years, 99.70 ± 30.40 mL/min/1.73 m2, and 123.47 ± 18.36 g/L, respectively. During a median of approximately 7-year follow-up, 183 cases reached the composite outcome. After adjustment for demographic and IgAN-specific covariates and treatments, a lower quartile of hemoglobin was nonlinearly associated with an increased risk of the primary outcome or kidney failure in the Cox proportional hazards models (primary outcome: HR for quartile 3 vs. 4, 1.37; 95% CI, 0.83–2.25; HR for quartile 2 vs. 4, 1.18; 95% CI, 0.68–2.07; HR for quartile 1 vs. 4, 1.91; 95% CI, 1.15–3.17; kidney failure: HR for quartile 3 vs. 4, 1.39; 95% CI, 0.84–2.31; HR for quartile 2 vs. 4, 1.20; 95% CI, 0.68–2.11; HR for quartile 1 vs. 4, 1.83; 95% CI, 1.09–3.07) in the fully adjusted model. Then, hemoglobin levels were transformed to a binary variable for fitting the model according to the criteria for anemia of 110 g/L in the women and 120 g/L in men in China. The participants in the anemia group had an increased risk of developing outcomes compared with the nonanemia group in both genders (primary outcome: male: HR, 1.64; 95% CI, 1.01–2.68; female: HR, 1.68; 95% CI, 1.02–2.76; kidney failure: male: HR, 1.60; 95% CI, 0.97–2.64; female: HR, 1.58; 95% CI, 0.95–2.61) in the fully adjusted model. Conclusions: A low level of hemoglobin was nonlinearly associated with IgAN progression. The anemic IgAN patients presented a higher risk of developing poor outcomes compared with the nonanemic patients.

Residues, potential sources and ecotoxicological effects of polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) were analyzed in typical urban river networks of Shanghai. In total, 47 surface sediments were collected in each of the sampling seasons (summer and winter). Laboratory analysis by GC-ECD showed that OCPs and PCBs concentrations were in medium levels compared to other national and international areas. As for OCP compounds, HCHs and DDTs were two dominant pollutants, with ∑HCHs concentrations ranging from 1.74 to 28.78 ng/g and ∑DDTs concentrations ranging from 0.88 to 25.45 ng/g. For individual HCHs, β-HCH was the most dominant HCH compound, with a mean value of 5.06 ng/g, followed by α-HCH (3.50 ng/g) in winter. A similar case of HCHs was also found in the summer season. Concentrations of ∑18PCBs varied from 6.67 to 37.10 ng/g in winter and from 10.63 to 45.55 ng/g in summer. Individual PCB 28, 101, 118 and 123 were dominant among all congeners, with averages of 3.16, 1.55, 2.47 and 2.37 ng/g in winter, 3.11, 2.34, 4.92 and 4.41 ng/g in summer, respectively. ∑20OCPs (the sum of twenty OCPs) concentrations in cultivated land areas were more abundant than that in artificial surface areas, indicating an abundance of pesticides and fertilizers in cultivated lands. Analysis of possible sources indicated that both industrial and agricultural residues contributed to higher HCHs and DDTs concentrations, which mainly originated from weathered pesticides with aerobic transformation processes. For PCB compounds, a significant seasonal variation, atmospheric precipitation, and surface runoff were the major factors for fluctuated PCBs concentrations. Ecotoxicological assessment based on established sediment quality guidelines (SQGs) showed that DDT compounds have a potential threat to the aquatic environment of our study area.

Dianshan Lake (DSL) as an important water source protection area in Shanghai is facing serious water quality deterioration. A detailed investigation of persistent organic pollutants (POPs) including polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs), and organochlorine pesticides (OCPs) in the multiphase system of DSL is very important for understanding their occurrence, sources, partition, and health risks. Total 11 sampling sites were selected including 3 inflowing rivers, 6 lake body sites, and 2 outflowing rivers. Total OCPs (Σ20OCPs) showed the highest concentration in water dissolved phase with a range of 47.8–143 ng/L. Total PAHs (Σ16PAHs) were the dominant compounds for suspended particle matter (SPM) and sediment phase, with a range of 2805–4130 and 206–4262 ng/g, respectively. The nonparametric test revealed the significantly higher concentrations of Σ16PAHs in sediment, Σ18PCBs in SPM, and Σ20OCPs in dissolved water from inflowing rivers than lake body (p Σ20OCPs (67.4 ± 27.0 ng/g) > Σ18PCBs (32.0 ± 13.7 ng/g), with obvious species-specific characteristics. The partitioning behaviors of PAH congeners in the water-SPM-sediment-fish system of DSL were greatly influenced by logKow values. However, the feeding habits (e.g., sediment-feeding behavior) of fish species played a predominant role in the bioaccumulation of PCB and OCP congeners compared to two-phase partition. Health risk assessments of POPs in dissolved water and fish samples revealed that only Σ16PAHs in dissolved phase have potential carcinogenic risk.

To investigate the characterization of PM2.5-bound polycyclic aromatic hydrocarbons (PAHs) and carbonaceous aerosols as well as the regulation of formation and transition in the haze episode, daily PM2.5 samples (from Nov.2017 to Feb. 2018) were collected from an industrialized district in Shanghai, China. The average concentrations of PAHs and element carbon (EC) were 10.4 ± 4.55 ng/m3 and 8.08 ± 2.97 μg/m3 during haze episodes, which were 1.33 and 2.27 times higher than those during clear period, respectively. Secondary organic carbon (SOC) consisting of 52.2% organic carbon (OC) were the main chemical constitution of the aerosols resulting in heavy haze in Shanghai. Spearman correlation coefficient indicated that low temperature and relative humidity were the crucial factors attributing to the severe haze events. The Positive Matrix Factorization (PMF) model indicated that vehicle emissions (33.2%) were the predominant sources during haze period, followed by coal and biomass combustion (32.5%), coking (25.5%) and petroleum spill and leakages (8.87%). Zhejiang, Anhui and Jiangsu provinces were identified as potential major source areas of PAHs and EC according to potential source contribution function (PSCF) and concentration weighted trajectory (CWT) models. This study made contributions to target the prevention of pollutants in terms of severe haze event and long-range transportation as well as putting forward control measures and policies.

Soluble Klotho (sKL) is closely related to insulin resistance, which is a major factor in the progression of diabetic cardiomyopathy (DCM). The purpose of this study was to investigate the role of sKL in the regulation of DCM and the mechanism involved. A mouse model of type 2 diabetes was induced by high-fat diet and streptozotocin injection. An insulin-resistant cardiac fibroblast model was established by high glucose and high insulin. KL gene overexpression was achieved in vivo and vitro through transfection with an adenovirus-harboring KL-cDNA. Gene overexpression was used to evaluate the role of sKL in the pathophysiologic characteristics of DCM. Insulin-resistant cardiac fibroblasts reduced sKL expression and collagen deposition. Diabetic mice constructed by streptozotocin exhibited severe insulin resistance, inflammation, fibrosis, left ventricular dysfunction, and sKL downregulation. The overexpression of sKL mitigated insulin resistance and metabolic disturbance; inflammation, fibrosis, and upregulated collagen I/III content ratio in diabetic state were significantly reduced. Our findings were accompanied by notable moderation of cardiac function. Further, blunted phosphorylation of Akt was restored with sKL gene overexpression, and activated phosphorylation of extracellular signal-regulated kinase 1/2 in DCM was reduced. Our results suggest that sKL protein overexpression exerts a defensive measure by ameliorating selective insulin resistance in mouse DCM, thus revealing its underlying mechanism for potential human DCM treatment.

Smokers often exhibit a stronger automatic approach bias toward smoking cues than nonsmokers on the Approach-Avoidance Task. However, previous research has often neglected the temporal dynamic of automatic processes in addiction and focused on immediate approach biases instead of delayed approach biases.Thirty-one male smokers and 30 healthy males were tested by an adapted Approach-Avoidance Task. In this task, immediate as well as delayed approach biases were assessed by manipulating cue-response time intervals.When exposed to smoking cues, smokers have significantly stronger approach bias than nonsmokers at a delay of 0 ms, 600 ms, and 900 ms rather than at 300 ms.This study found that smokers have a strong, immediate approach bias toward smoking-related cues. But this approach bias will keep changing with increased cognitive processing time. Temporal dynamics may be an important feature of the addiction-related approach bias.

Shallow urban lakes are important urban ecosystems; however, these systems are subject to severe polycyclic aromatic hydrocarbons (PAHs) contamination. An understanding of the distribution and dynamics of PAHs in lakes is required to restore the functions of lake ecosystems and to ensure the ecological security of urban water sources. The Quantitative Water Air Sediment Interaction (QWASI) model and partition coefficient and fugacity fraction methods were applied to estimate the multimedia transfers of PAHs in Dianshan Lake, a typical shallow lake in Shanghai, China. In addition, some new concepts and methods related to PAH transfers were introduced. The results showed that while the gas-solid partition in the area remained in non-equilibrium, the influence of pollution sources tended to weaken. Atmospheric advection was the main source of PAHs to the lake, and a portion of the net loss of advection was transformed into total flux of cross-interface transfers, in which transport fluxes from air to water and from water to sediment were dominant, with a significant correlation between the two types of transfer. The large resuspension of high molecular weight (HMW)-PAHs occurred, possibly related to frequent hydrodynamic disturbances. Furthermore, this study explored the distribution of PAHs among different compartments and the seasonal variation of multimedia transfers. Sensitivity analysis showed that the model is remarkably sensitive to four parameters including temperature and advection. Monte Carlo uncertainty analysis verified that the simulation results were stable and reliable. The results can provide a theoretical basis for the monitoring and control of shallow lake pollution.

Artificial neural networks (ANN) have achieved successes in many fields, such as pattern recognition and speech recognition etc.. In this paper, we will summary its applications in the source reconstruction for electromagnetic interference (EMI) diagnosis in two ways. Firstly, near-field scanning is used to obtain the near-field data, and then ANN is used to reconstruct the equivalent EMI sources from the near-field. Both amplitude and phase of the near-field are used in our methods. The first case is to show the ability of ANN to consider multi-reflection and/or diffraction effects in EMI source reconstruction. The next case is to show how to reconstruct EMI sources in an iterative way with ANN. Both two cases are verified by measurement examples.

Polycyclic aromatic hydrocarbon (PAH) contamination in agricultural soils (n = 41) along Shanghai road net was systematically investigated to characterize pollution distribution and to apportion sources. Total PAH (Σ16PAH) concentrations in roadside agricultural soils varied from 17.2 to 3775 ng/g with an average of 339 ± 594 ng/g, 43.9 % of which corresponded to weakly - heavily contaminated levels. The spatial distribution of pollution hotspots depended on heavy traffic volume and intensive industrial activities in adjacent areas. A positive matrix factorization receptor model identified that vehicle emission and combustion of coal, biomass and natural gas were the predominant sources, accounting for 66.0 % and 23.7 % of Σ16PAH loadings, respectively. Stable carbon isotope analysis was applied for the first time in seven sites with high Σ16PAH concentrations for tracing their unique sources. It was concluded that PAHs in the heavily contaminated soil site G18 predominantly came from vehicle emission sources, different from the six other sites controlled by coal-processing and biomass combustion sources. Future studies should focus on quantifying the source contribution of PAHs in roadside agricultural soils based on the combination of multi-isotope approaches due to the data overlap of δ13C in certain sources.

Background: The role of serum uric acid (SUA) level in the progression of Immunoglobulin A nephropathy (IgAN) remains controversial. Methods: In a cohort of 1,965 cases with biopsy-proven IgAN, we examined the associations of SUA concentration with the primary outcome of a composite of all-cause mortality or kidney failure (defined as a reduction of estimated glomerular filtration rate [eGFR] by 40% from baseline, requirements for dialysis and transplantation), or the outcome of kidney failure alone, assessed using Cox and logistic regression models, respectively, with adjustment for confounders. Results: At baseline, the mean age was 33.37 ± 11.07 years, eGFR was 101.30 ± 30.49 mL/min/1.73 m2, and mean uric acid level was 5.32 ± 1.76 mg/dL. During a median of 7-year follow-up, 317 cases reached the composite outcome of all-cause mortality (5 deaths) or kidney failure (36 cases of dialysis, 5 cases of renal transplantation, and 271 cases with reduction of eGFR by 40% from baseline). After adjustment for demographic and IgAN specific covariates and treatments, a higher quartile of uric acid was linearly associated with an increased risk of the primary outcome (highest versus lowest quartile, hazard ratio [HR] 2.39; 95% CI 1.52–3.75) and kidney failure (highest versus lowest quartile, HR 2.55; 95% CI 1.62–4.01) in the Cox proportional hazards regression models. In the continuous analysis, a 1 mg/dL greater uric acid level was associated with 16% increased risk of primary outcome (HR 1.16, 95% CI 1.07–1.25) and 17% increased risk of kidney failure (HR 1.17, 95% CI 1.08–1.27), respectively, in the fully adjusted model. The multivariate ­logistic regression analyses for the sensitive analyses drew consistent results. In the subgroup analyses, significant interactions were detected that patients with mean arterial pressure (MAP) < 90 mm Hg or mesangial hypercellularity had a higher association of SUA with the incidence of the primary outcome than those with MAP ≥90 mm Hg or those without mesangial hypercellularity respectively. Hyperuricemia was not significantly associated with the risk of developing the primary outcome in elder patients (≥32 years old), patients with eGFR < 90 mL/min or with tubular atrophy/interstitial fibrosis. Conclusions: SUA level may be positively associated with the progression of IgAN. It was noticeable that the association of hyperuricemia with IgAN progression was less significant in patients with elder age, lower eGFR, or tubular atrophy/interstitial fibrosis, which may be due to some more confounders in association with the IgA progression in these patients. Future prospective studies are warranted to confirm these findings and to investigate the underlying mechanisms.